CHOQUISIS, Guatemala—In this tiny, impoverished village, burrowed in the jagged mountains of Guatemala's Western Highlands, Cristina Itsep Perez is making million-dollar gruel.
Under a corrugated tin roof, in a one-room kitchen adorned with colorful pots, pans, and baskets, she's furiously mixing Mi Comidita, a corn-and-soy blend fortified with 19 vitamins and minerals. The Canadian government has poured $2 million in aid into the product—a super-cereal for kids during their pivotal first two years, and specially designed for a country with the world's fourth-highest chronic undernutrition rate for children under five. In isolated, largely indigenous communities like Choquisis, child malnutrition rates can reach 70 or 80 percent, severely hindering kids' ability to grow, learn, work, and lead healthy lives for years to come. These dubious distinctions make Guatemala a laboratory of sorts for innovations in the production and delivery of micronutrient-fortified food.
It's a surprisingly vibrant field. The U.S. Department of Agriculture and Hormel Foods, for instance, have engineered a vitamin-stocked turkey paste called Spammy that comes in a tuna-can-like container with a cartoon turkey on the front, and is served to Guatemalan schoolchildren in the form of chuchitos, dobladas, and tostadas. The U.S. Agency for International Development (USAID) has turned to a computer-software program called Optifood to identify local foods, fortified foods, and micronutrient powders that can fill gaps in Guatemalans' diets at the lowest possible cost.
As for Mi Comidita, there's a method to how it made its way from the outskirts of Guatemala City, where the food is manufactured, to Perez's stove. Each month, the World Food Program and the Guatemalan government distribute two bags of Mi Comidita to each family that visits a local health center, incentivizing parents to get their children check-ups and vaccinations. The recipe is simple, requiring nothing more than a pot, a spoon, a measuring cup, and hot water, and no more than five minutes of prep time (long cooking times can degrade nutritional value). Instructions include pictures for those who are illiterate. The fortified food is integrated into a program in which mothers serve as madres consejeras, or "mother-counselors," for other pregnant and nursing mothers seeking advice on breastfeeding and proper nutrition. The groups meet once a month.
I met Perez, a madre consejera, during one of these sessions, on a sticky spring morning in Choquisis. Flanked by other members of her group, the 38-year-old mother of one prepared Mi Comidita over an open flame, using water from a nearby well.
Foods like Mi Comidita are invented to address specific micronutrient deficiencies in certain populations, and in recent years new technologies have emerged to produce such products in a more sophisticated fashion. The linear-programming software Optifood, for example, runs on data about local dietary patterns and food costs. Last year, USAID wrote about how it enlisted FANTA, a food-security project it funds, to collect information on diets in Guatemala's Western Highlands. Then Optifood took over:
The Optifood analysis found that a combination of locally available foods including tortillas, potatoes, beans, eggs, green leafy vegetables, and a fortified cereal known as Incaparina, along with mother’s breast milk, could satisfy children’s nutrient needs, except for two nutrients required for children 6-8 months—iron and zinc. Optifood results showed that adding a micronutrient powder, known locally as Chispitas, would help make sure these very young children get enough iron and zinc....
FANTA then found out how much this diet would cost and whether families in the Western Highlands could afford it..... Optifood found that it would cost about 25 to 50 U.S. cents a day to give this improved diet to a child 6–23 months old in Guatemala. At first, this may not seem like much money, but for the 51 percent of the population in the Western Highlands who earn less than US$3.15 a day, it amounts to 8 percent to 15 percent of their daily earnings.
Optifood might churn out an analysis like the one below, which identifies gaps in nutrition resulting from eating habits or scarcity in local food sources. The modeling software then makes recommendations about what available foods and additional supplements the target Guatemalan population should consume—and how much, how often, and at what cost.
Optifood, however, only does so much to chip away at a complex problem like malnutrition. It's one thing to make recommendations; another for them to be implemented effectively by aid workers and the beneficiaries themselves. As one Journal of Nutrition study noted, fortified food, which requires special manufacturing and packaging, can be prohibitively expensive for poor people, especially when cheaper, non-fortified versions of the food are available in the local market. The cost of diets suggested by Optifood, which are sometimes dramatically different than existing diets among a target population, can exceed what typical households earn per day.
Any fortified-food initiative also needs to be part of a larger campaign to educate beneficiaries about proper nutrition. If the women of Choquisis don't understand the holes Mi Comidita is filling in their children's diets, and what kinds of foods could replace it if the supplement isn't available, then the intervention will cease to be valuable as soon as the World Food Program and Guatemalan government wrap up the project.
The fundamental problem, the Journal of Nutrition paper explained, is one of supply and demand: those delivering nutritional aid have often focused on supply at the expense of demand. Instead, the priority should be empowering recipients to understand malnutrition and devise their own solutions: "In this way, the households, individuals and communities can become 'demanders' of services, and the service delivery processes can be gradually adapted to meet the demands," the authors wrote. If the demand is for more bags of Mi Comidita, then so be it.
This reporting was made possible by CARE with support from the Bill & Melinda Gates Foundation.
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